| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,748 |
1,511 |
$26K |
| D1120 |
Prophylaxis - child |
1,062 |
913 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,401 |
1,230 |
$19K |
| D1110 |
Prophylaxis - adult |
200 |
167 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
93 |
77 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
40 |
$822.52 |
| D0274 |
Bitewings - four radiographic images |
27 |
24 |
$359.25 |